Gluten Intolerance Called an “Impending Epidemic” in India

Robert Burns Woodward did not conduct these studies. We just like this picture.

Since most of our readers live the states or Canada, we don’t often talk about gluten free products or news happening in other countries. When we do, it’s usually Western countries like Sweden or Italy. But the Triumph community is growing faster than ever, and I think it’s high time we started looking at what it’s like to be gluten free all over the world.

With perfect timing, a piece of news out of India just landed in my e-mail, so we’ll start there. A recent editorial in the Indian Journal of Medical Research calls gluten intolerance “an impending epidemic” and questions what, if anything, the country can do to prevent it from becoming a widespread problem.

The piece, an editorial by B.S. Ramakrishna of the Christian Medical College in Vellore, India, points out that information on celiac presence in south Asia – where India is located – is rare, but that prevalence in the region is believed to be quite low. This rarity is most often attributed to the fact that rice, not wheat, is the dietary staple in much of southeast Asia. Same goes for sub-Saharan Africa, where maize is the staple cereal in the diet.

But lately, a lot of that has been changing. Celiac started to pop up in northern India in the 1960’s, most often in children. Today, the estimated rate of celiac in Ludhiana, the largest city in the northern Indian state of Punjab, is 1 in 310 (in America it’s at about 1 in 133). Conversely, in south India rates of celiac are so low that there’s little statistical evidence about it, although anecdotal evidence from doctors in the region suggest it’s extremely rare.

Why? Well, one factor could be diet. In south India, rice is the main dietary staple, unlike in north India where wheat is more popular. Another possibility, according to the editorial, is differences in genetics, although it goes on to say that not enough is known about genetic differences between south and north Indian populations to say either way (and I’m guessing that racial tensions between south and north Indians might mean that scientists have to tread lightly when claiming genetic differences between the two regions).

A third possibility has to do with the type of wheat. Ancient types of wheat are diploid (having two sets of chromosomes), while modern wheat is hexaploid (meaning it has six sets of chromosomes). Diploid wheat is far less capable of inducing celiac disease, but hexaploid wheat is the most common kind in north India (and in much of the world).

Ultimately, the piece suggests that a return to older types of wheat might curb the spread of the disease, as well as coming up with infant feeding standards that have been proven to reduce the risk of celiac.

I think what’s really interesting here is the opportunity to see the evolution of celiac in a population from the very beginning, and having the chance to see what can be done to stop it. Being able to see, first-hand, how celiac starts to spread and whether or not it can be stopped will give us tons of insight into celiac treatment and prevention. Another interesting thing is the general implication here that modernization seems to lead to increased incidences of celiac disease. A lot of anecdotal and scientific evidence seems to point to this conclusion, and it’s another peek into potential prevention and treatment possibilities. Maybe eating as simply and naturally as possible – as opposed to spending a ton of money on processed gluten alternatives – is the best way to go in the end.

What do you all think? Are you part of a population that doesn’t typically get celiac disease? Have you struggled because of that? Do you think rising rates of celiac in India have connotations for the way we think about celiac in the West?

2 thoughts on “Gluten Intolerance Called an “Impending Epidemic” in India”

I lived in China for four years, right before I was diagnosed with celiac, but having had unexplained digestive problems for at least 10 years. My symptoms were much better while I lived in China, although we lived in the northern part where all kinds of bread, dumplings and other wheat products are just as common as rice. One thought was that all the ginger, garlic and maybe different onions had an anti-inflammatory effect, although I wasn’t able to improve my symptoms back in the US with eating a lot of these. Another possible difference I consider quite possible is that the wheat in China is different, and not as irritating, possibly because it is not as high in protein as what we used in the US. I read these kinds of news stories with great interest!

As doctors in India have now become more aware of celiac disease, the number of diagnosed cases has started rising. North Indians are mainly wheat eaters, while rest of India, including Bengal and Assam in the east, is mainly rice eating. This explains why celiac disease is mostly a problem in the north – it has nothing to do with genetics. The racial hypothesis delicately suggested is wrong. A genetic study of Indian population revealed that almost all Indians have a dominance of what is called the Ancient North Indian (ANI) group. A few tribal populations in the eastern seaboard and all tribes in the Andamans belong to a different group called the Ancient South Indian (ASI). It is possible, but highly unlikely, that the north Indians have developed special variations to cope with their wheat eating.